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NPI Code Detail

MEDICARE: DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC

MEDICARE: DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2363L00000XNurse Practitioner
3207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1205293842
Entity Type Code : Organization
Provider Name (Legal Business Name) : DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Provider Business Mailing Address
First Line : 1105 FAIRGROVE CHURCH RD SE
Second Line :
City : CONOVER
State : NC
Zip : 28613-9090
Country : US
Telephone Number : 615-920-7000
Fax Number :
Provider Business Practice Location Address
First Line : 1105 FAIRGROVE CHURCH RD SE
Second Line :
City : CONOVER
State : NC
Zip : 28613-9090
Country : US
Telephone Number : 615-920-7000
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JESS JUDY
Credential :
Telephone Number : 615-920-7000
Provider Enumeration Date : 01/27/2016
Last Update Date : 01/27/2016

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Directions to “DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC ” Practice Location

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